Separate continuous learning from annual comparison

Healthcare needed a national system that could help hospitals improve patient experience continuously while also providing public, comparable results. e-Satis addresses the practical tension between timely feedback that local teams can use and a slower, more controlled annual comparison that the public can interpret fairly.

e-Satis currently has four deployed streams: hospital stays over 48 hours in medicine, surgery, and obstetrics; ambulatory surgery; medical and rehabilitation care; and adult inpatient psychiatry. For the two documented MCO streams, hospitals deposit eligible patients' e-mail details on the national platform unless the patient objects. Two weeks after discharge, patients receive a unique secure link and have eight weeks, with reminders, to respond.

Hospitals receive raw scores, dimension results, and free-text comments through the detailed-results platform as they are collected. HAS then produces annual adjusted establishment results for public comparison; at least 30 complete, usable responses are required for that comparison.

One source system can legitimately produce two different outputs: real-time raw feedback for local improvement and annual adjusted results for comparative/public use. The output purpose needs to travel with the number.

e-Satis makes that distinction operational. The annual public layer uses adjusted results, a minimum response threshold, and an annual public A-D performance band based on each establishment's adjusted score for that survey; a raw local score is not presented as though it has the same meaning. The lesson is not to suppress local feedback, but to avoid presenting it as a fair benchmark before it meets the conditions for comparison.

e-Satis is a national programme family, not one universal questionnaire. It combines sector-specific streams, a shared national platform, continuous collection, and a separate annual reporting layer. This shows how a programme can retain national discipline while allowing the instrument to reflect materially different care settings.

The central scope lesson from e-Satis is that sector-specific instruments should follow the patient's care pathway. This is a synthesis from the HAS stream designs: the ambulatory-surgery questionnaire covers preparation before hospitalisation and return home, whereas the +48h inpatient questionnaire covers the experience of a longer stay, including medical care, nursing and allied care, room, meals, and discharge organisation.

e-Satis therefore sits chiefly at the episode level, but its questions extend into the beginning and end of that episode where those stages matter to the patient. It does not serve as a measure of the longer-term care pathway across providers or of life impact after treatment.

The questionnaires follow the care pathway rather than imposing one generic view of hospital experience. The +48h MCO questionnaire has six dimensions, including medical care, nursing and allied care, meals, and discharge organisation; the ambulatory-surgery questionnaire includes preparation before hospitalisation and return home. Both were co-constructed with service users and health professionals.

Their question design is deliberately hybrid: PREM-style questions ask about observable parts of care, such as whether information was given, while satisfaction questions ask patients to rate the quality of that information or aspect of care. This teaches that a setting-specific module can reflect the patient's actual pathway while distinguishing what happened from how the patient judged it.

e-Satis is not feedback while care is still happening: the documented MCO streams first contact patients two weeks after discharge. It is nevertheless continuous, because hospitals deposit patient details regularly and can see raw results and comments as they arrive. The lesson is that timely operational learning can be post-discharge, but it should be clearly separated from the annual comparative cycle.

e-Satis is digitally enabled by design: it uses a national e-mail and web-survey platform, provides real-time detailed results, and since 2024 has included automatic thematic classification of free-text comments. HAS developed that tool with a hospital partner and a working group including quality professionals and patient representatives. The lesson is that technology can make qualitative feedback usable at scale.

HAS describes a generic, reproducible method for developing and scientifically validating e-Satis indicators. It tests feasibility, relevance for improving care quality, the questionnaire's metrological properties, and adjustment of results.

HAS estimates that producing a reliable indicator takes about 18 months.

The documented e-Satis streams were co-constructed with patients and field professionals, and their questionnaires are validated by HAS.

e-Satis has evolved as a programme rather than remaining fixed: the original +48h MCO stream began in 2016, ambulatory surgery followed in 2018, medical and rehabilitation care in 2020, and adult inpatient psychiatry in 2025.

The detailed-results platform added automated free-text classification in 2024, and HAS is also developing or testing measurement for further settings. The lesson is that a national programme can add new care contexts and new forms of analysis while retaining a governed reporting architecture.